Anxiety and Stress Management

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2010-03-01T12:03:00.001-05:00

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SAD: The Demon Beast of Winter

2008-11-17T12:30:00.002-05:00

Winter comes this year with a promise of holidays that may not be as bright as we would like. In the middle of a pounding economic downturn with job loss and belt tightening all around, there is another spectre that is there whether the economy is good or bad and it's Seasonal Affective Disorder, originally called the Winter Blues. Imagine how difficult it is for people with this disorder (SAD) and then add on top of that the problem of lack of money and the stress that brings. It's a one-two punch no one wants, especially with reduced economic and psychological resources. An estimated 25% of the population suffers from a mild form of SAD and around 5% has a more severe winter depression.

SAD often affects groups who live above certain latitudes. So, it would seem, people often referred to as 'snow birds' know what they're doing when they head south for the winter. It may not be just the cold they're escaping, it may be depression. The shift that takes place in our biological clocks happens in response to the light that hits our eyes and affects our internal settings.

A small structure in our brains, the pineal gland, produces a substance which can be both problematic and helpful. The substance is melatonin and it has been linked to both SAD and sleep. During the winter months, the decreased exposure to sunlight may stimulate the production of this hormone.

How do you know you have SAD and what can you do about it? First, let's look at the usual symptoms we see with this winter variety of the disorder. Yes, there's a summer disorder, too, for some people.

SAD Symptoms

January to February is the prime time of year in most Northern climes and we see:

Changes in sleeping and eating habits

Persistent sad, anxious or "empty" mood

Loss of pleasure in activities once enjoyed

Depression subsides in the spring and summer months.

Symptoms have occurred in the past two years, with no non-seasonal depression episodes

Seasonal episodes substantially outnumber non-seasonal depression episodes

The individual craves sugary or starchy foods probably because this increases the availability of serotonin which fights depression

As a result of the dietary changes seen, there is weight gain and that further increases depression by lowering self-esteem and intensifying feelings of helplessness. Your clothes don't fit, you can't buy new ones and you feel self-conscious. Double whammy there.

Steps You Can Take

Light box or visor treatments

Dawn simulation devices for morning awakening

Antidepressant medications

Outdoor or even indoor exercise such as walking for as little as 15 minutes a day

Our thinking about how to treat SAD has changed since 1984 when Dr. Norman Rosenthal first described the disorder. Light boxes aren't seen as necessary because we've discovered that light, from any source, may be beneficial. The most interesting results have come from just plain old exercise several times a week and it can be indoors or outdoors. Walking is one of the exercises that has been found to be both useful and to involve no cost. Leave the car a few blocks away from where you've going shopping or at the edge of the parking lot, walk to the stores, take a walk around your neighborhood or in front of the TV. You can probably, if you have a high-tech home, use TV exercise programs such as the virtual tennis, yoga and other programs. This way, you avoid the cold weather and still get your anti-depression exercise fix. In the office, get up and walk things over to your colleagues, walk to the water cooler a few times a day and walk up and down stairs.

You do have resources and you can overcome this disorder, so get walking.

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Alcohol, Stress and the Holidays

2008-11-12T18:19:00.003-05:00

Alcohol has its many advocates in the literature of the past several centuries and it has all those witty phrases we've come across. The phrases include, "A day without wine is like a day without the sun," and "In vino veritas" (In wine there is truth). George Bernard Shaw is reported to have said, "Alcohol is the anesthesia by which we endure the operation of life" and Benjamin Franklin is quoted as saying, "Beer is living proof that God loves us and wants us to be happy." History tells us that Franklin along with many of the other Founding Fathers, was a great consumer of things alcoholic. Water, after all, was not considered fit to drink, so alcohol filled the bill for daily fluids.

The holidays are around the corner, the economy seems to be headed for a long recovery period and alcohol may play an increasing role in the lives of people in the months to come. Not just a drink for celebration, alcohol, as many of us know, is a powerful non-prescription drug that can lift someone's mood, temporarily, help with anxiety and may be beneficial to our health. All of this should be taken with a grain of salt, as the saying goes.

Red wine has come into the medical literature as something that can help with a variety of physical disorders or illnesses and, working in nursing homes, I have heard physicians prescribe a "drink" at dinner for some residents. Yes, prescribe. It has to be written into the orders or it can't be dispensed by the nursing staff. Some residents have their own liquor stored in the nursing station cabinets. I knew of one patient who had champagne for special occasions in her room. She had a terminal illness and champagne was seen as the least of her problems.

Alcohol, unfortunately, also has the ability to cause serious disinhibition with serious, sometimes fatal consequences. We've seen the stories about initiations where a bottle of alcohol has to be consumed at one sitting, or in one elongated gulp-session. In these instances, alcohol acts as a fatal poison for the breathing center of the brain. For others, alcohol facilitates actions which result in not a calming effect, but a rage reaction and not Franklin's "proof." Statistics on suicide related to the current economic gloom won't be available for another two years and one wonders what the stats on alcohol consumption will show and if there might be a relationship.

Yes, alcohol has its place in life as we've seen from its use in many ceremonies, family gatherings and holiday parties. It can serve as a mild aid to the socially sensitive, but its potential for harm has to be considered, too. The researchers who've seen some alcoholic beverages as beneficial are always cautious to say that it has to be used reasonably and, as any drug, with an eye to abuse. What is your limit on alcoholic drinks? You should know what it is and keep yourself within a safe limit. That's not me preaching, it's just good sense.

The National Center for Health Statistics (2007) found that 33% of current drinkers had five or more drinks per day in the past year; in 2005 there were 21,634 deaths related to alcohol excluding accidents and homicides. Alcohol deaths were 3.2 times more likely to occur in males as females. One of the major problems with alcohol, in addition to these grim statistics, is that anxiety is related to alcohol abstinence. So, if you drink to help handle your anxiety, trying to cut down on your drinking will result in more anxiety which, in turn, leads you right back to drinking again.

What the National Institute on Alcohol Abuse & Alcoholism Suggests

First, you have to be honest with yourself and answer a few questions:

Do you drink alone when you feel angry or sad?

Does your drinking ever make you late for work?

Does your drinking worry your family?

Do you ever drink after telling yourself you won't?

Do you ever forget what you did while you were drinking?

Do you get headaches or have a hang-over after you have been drinking?

One "yes" response can indicate you have a drinking problem and you may need professional help to stop. If you do agree that you need help, you can begin helping yourself right now. Steps that are suggested include:

Write down your reasons for cutting down or stopping drinking.

Set a drinking goal. Not a bad idea whether or not you have a problem with alcohol.

Write your drinking goal on a piece of paper and keep it where you can see it.

Keep a daily diary of your drinks that includes the number of drinks, what they were and where you did your drinking.

Take a break from alcohol and make at least one or two days a week alcohol-free days.

Stay active and get involved in something that doesn't include alcohol.

Seek out support from family, friends or groups.

Remember the places, people and times of great temptation for you. Plan ahead when you are going to social or business events so you can avoid drinking or going over your limit.

Don't drink when you are upset or angry.

Do not give up. It takes time, like anything else, to reach a goal and along the way there are going to be things that will make you want to toss in the towel.

Remember, there are always going to be "reasons" to drink that don't include special occasions or ceremonies and you don't want to take the bait. One of the most unfunny and, potentially disabling remarks I've ever heard is, "Well, it's 5 o'clock somewhere, so we can begin drinking now." Not funny.

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Our Economic Crisis and the Role of Fear

2008-10-01T19:24:00.001-04:00

Fear is a potent force which nature has provided to help all of us stay out of harm's way. Unfortunately, it can also cause us to act rashly in situations where restraint rather than a knee-jerk fear response is required. When fear enters, reason leaves the room.

Fear can be used to both push people to action or dissuade them from doing something. It's something politicians, researchers and patriarchs have known for ages. The research that has been done over the years involved contrived situations of smoke coming into a room, someone falling down onto a subway platform or even horses in a group. The undercurrent of fear was in each one of these and other social psychology scenarios and it illustrated how fear can cause action or keep you glued to your seat.

In addition to actions, fear has its buzzwords such as: layoffs, termination, economic crisis, foreclosure, terrorism and many others that you can think of on your own. The thing to do, however, is to allow yourself not to immediately let that adrenalin kick in and push you to rash into action.

When fear rears its ugly head:

Take time to pull back from the situation and delay immediate action - unless there's an open artery involved.

Breathe! If you don't know how to do relaxation breathing, go to my Self-help page

Try to be around people who are calm; it's infectious in a good way

Sit down and ask yourself to look for the positive side in this or the solution that is currently not being seen. Reach out to others.

Let Scarlet O'Hara be your guide for a moment and remember that "tomorrow's another day." Even Annie knew that "the sun will come out tomorrow."

Understand that FDR was right when he said, "The only thing we have to fear is fear itself." Don't let it crush you in its grip.

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Ten Rules for Taking Back Your Life

2008-09-15T17:27:00.002-04:00

The weather is turning from summer into fall and with it comes cooler days, longer nights and an initial surge of hurricanes. But you don't have to see this as all bad news even if the the economy hasn't come back the way most of us would have wanted. Terrorism continues around the world and corporate scandals are still making front page news but I see a positive side.

My personal belief and the belief that you'll find throughout my book is that for every bad thing that happens, there is a corresponding good thing to be found - if you let yourself see it.

Taking back your life is a matter of deciding that you're in the driver's seat, not someone else. It doesn't matter if the economy's bad, you can't go on a super special vacation this year or you are feeling lonely, everything has a positive side. Here are my 'rules' for turning things around for yourself, rather than waiting for something or someone to do it for you.

Life 'Rules'

Challenge yourself to use every 'bad' thing in your life as a new beginning.

Find the 'good' in everything that you can.

Don't expect the good things to be readily apparent. It may take a few days, weeks or even months before you finally see them.

Allow yourself to realize your true power. This doesn't mean pushing people around, but looking for your hidden skills.

Talk to yourself. Talking to yourself is a very powerful tool to use and it can help you increase your motivation and your ability to stick to a task.

Stop expecting others to solve your problems. Even if you lost your job, it's an opportunity to look in a new direction, to acquire a new skill and to blaze a more pleasurable path in life.

Throw out that 'yes, but' expression from your life. It's just a way of keeping yourself stuck in the mud.

Take a good hard look at what you'd really like in life and sit down and begin making a list that outlines the steps you need to take. Not everyone needs to go to college to be happy. Find out where your happiness lies, if you don't want to go back to school. Abraham Lincoln did just fine with his self-learning plan.

Beware of the negative people in your life. Pointing out the problems is fine, but some people only see doom and gloom and they can't be very helpful, unless you find that helpful.

Remember that every road has unexpected turns and that any plan must be one that allows for some give and take. If there's one word for your plan to take back your life, let it be 'flexible' and go from there.

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Who Said MDs or PhDs Don't Feel Like Everyone Else?

2008-08-26T10:00:00.001-04:00

I had a conversation recently with someone who was doing her job while she talked to me and one statement she made rang out like a loud bell. "Well, you psychologists are trained not to feel grief like the rest of us." Trained not to feel grief like the rest of you? Did she honestly think that anything in a psychologist's training could remove the ability to respond like any other human being from any of us so that we'd be immune to feeling emotions like grief? How would they have done that? It certainly wasn't part of any training I got.

Than I started thinking about the physicians I've known and how, when they're being open and honest with you, they admit to the grief when a patient dies or when they can't help them with an illness. Not all of them and that's probably because some have formed a hard mental callus that seems to protect them, but I wonder. Some others see patients as walking, talking bits of anatomy, jobs to be performed, chests to be thumped and meetings to be placed on little white cards. Some are terribly naive about life because they've spent their early adulthood in laboratories or writing papers or trying to impress their professors or chiefs of service and missed out on living.

Those are the ones who stand at the doorway to patients' rooms and announce loudly, "Oh, yes, the test results came back and you've got cancer," and walk away. I've seen that happen.

Most of us feel grief and all the normal human emotions the rest of the world experiences. We cry and regret and love and that's normal. As the famous newspaper letter of many years ago (circa 1897) indicated (I take a bit of license here), "Yes, Virginia, there is a feeling psychologist."

Well, I should say there is more than one.

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Technorati Tags: anxiety, stress, grief, empathy, compassion, psychologists

Making Back to School Less Traumatic

2008-08-18T12:22:00.001-04:00

Fall brings with it a return to the work world for adults and to school for children. Whether it's kindergarten, grade school, high school or college, school has its challenges and so does work. The US Government recognized that school was actually children's "work" when it permitted Disability allowances for children who couldn't perform adequately at school. How children perform in school isn't only a function of their individual abilities, but a part of the equation where parents and community play a major role.

The number of children who will be diagnosed as having anxiety disorders or depression is sufficient for us to recognize that it's a very real problem that has life-long consequences. I've seen estimates of 19 million children diagnosed with anxiety.

An anxious child cannot concentrate sufficiently to absorb what is taught in the classroom and, therefore, that child is at a disadvantage academically. If this goes on for a few years, the child falls farther and farther behind his/her peers and the problems associated with going to school mount as do the behavioral problems associated with poor performance in school. It was once called 'school phobia,' but it is more appropriately recognized as much more than one single problem. The anxiety these children feel stems from their social interactions, the school requirements, their preparation for school and the home to which they go each afternoon. All of it must mesh in order for this child to succeed to the best of their abilities.

New Golden Rules

My golden rules for school include:

Read to your young child each evening, if you can and help them to discover the wonder of reading. Reading is probably your child's most valuable key to learning. If they can't read well, it is like putting a huge bolder on the road before them and giving them no tools to move it. Reading builds vocabulary and this is one central element in all testing.

Help your child "grow" their vocabulary. If possible, encourage participation in word games or even word-find puzzles. Words can be the key to opening an interest in history and social studies, so use the origin of words to broad their interests.

Teach your child how to organize their activities and their study materials. Anxiety is compounded by not being able to find materials and when deadlines are put off until the last minute. Here we have the beginning of the 'the dog ate my homework' scenario.

Set up a schedule for school-related activities and those your child enjoys with friends or family. Remember the saying "all work and no play makes Jack/Jill a dull boy/girl?" Don't make your child's day an endless series of "must do" activities.

Remember that later in their school experience critical thinking will be invaluable and it's in the beginning years of school that you help shape this ability. "Why" questions are a way children begin this search for meaning in their world. Direct them to something that will provide answers they can understand and enjoyment at the same time.

Relaxing is just as an important part of your child's day as working. How many children are taught how to relax? I don't think people realize their children may need some help in learning to relax because they still think that a child's world is one devoid of problems and just packed with fun. If it were, how come so many kids are anxious? What about relaxation breathing that can be done at home or in school when they become tense?

Plan family activities and give your children something to look forward to other than summer vacation. It's good for them and it's good for you.

Begin to help them develop problem-solving skills and help them understand that some things take thought and planning and can't be solved immediately. Build up their ability to control their impulsivity. It's wonderful to want to do things NOW, but it's not always the best route. Maze games make this point beautifully.

Encourage skill development in some sport or activity. This helps build self-confidence and acceptance that sometimes mistakes are a part of learning. Whoever shot a hole-in-one the first time they went on the golf course? Why should you expect your child to do something like this the first time they try something? First times are beginnings and you want to let them have as many beginnings as they want or need.

Offer a helping hand, a soft shoulder and a ready ear and you will be giving your child one of the greatest gifts they will ever receive.

Are you a BlackBerry Addict?

2008-07-24T12:37:00.001-04:00

Technology, like stress, is the wily bookkeeper who keeps juggling the books, and not always in our favor. Lately, I've been listening to more and more discussion about BlackBerry addiction, so I started giving it some thought. Could you really be addicted to a PDA or wireless device and, if you were, what would be the signs that would tell you? And, is it "addiction" or "dependence?" There are differences. I have a feeling it fits more into the realm of dependence and, like any dependence, it definitely has a down side. BlackBerry is big and the most recent statistics on its sales indicate, according to CNN Money.com, that the quarter ending March 2008 saw $1.88 billion in sales and about 2.18 million new subscribers for just that quarter.

Signs of Dependence

When you look for dependence, you want to see if any of the following have been affected by, usually, a substance, but in this case it's a wireless device.

Are certain activities in your life reduced by your use of this device?
Do you use it excessively?
Do you find it nearly impossible to cut down on your use?
Despite knowing that it causes you stress and tension in your family life, can you not stop using it?
Do you spend large amounts of time using it or in wireless- device-related activities?
If you can't use it, do you have physical symptoms of sweating, anxiety and even nausea?
Have you developed a tolerance that leads you to use it more and more?

Well, my friend, all of those are signs of dependence and let's, for one moment, consider what this might do to you. Like an intrusive friend who seems to be helping you, this usage quickly becomes more important than anything else. You NEED it because you HAVE to be available and you NEED to keep up on things. Do you ever have it far from your side and where do you put it at night? Is it ever off? Do you jump when you get a call and does your heart beat increase?

Try one little thing to see how it might be causing you stress. When the signal comes through that you've got a message or a call, put your index and middle finger over your left wrist bone (where the pulse is) and count the beats. Record and date it somewhere. Then, at some other time, when you're doing a relaxing activity, take your pulse. Is there a difference?

Okay, have you developed a dependence and, if so, what might you do about it? Being under constant stress is unhealthy both physically and mentally. The effect won't be immediate, just like the work of that bookkeeper, but it will be there.

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Technorati Tags: blackberry, pda, technology, stress, health and wellness

Stressful Jobs and Depression Risk

2008-07-03T08:30:00.001-04:00

Stress is a part of life and when it comes to our jobs and how we make a living, it's something that requires our constant care and concern. Now a new study of 1,000 workers in Europe found that stressful jobs accounted for 45 per cent of new cases of depression. The factors which the scientists isolated as being especially important were excessive demands on the job and extreme time pressures. Not only did they find that these workers, with an average age of 32, were experiencing a high percentage of job-related stress-induced depression, but there appeared to be a 40 percent increase in reports from workers of job stress.

When economies turn sour, the heat is on in terms of producing the same with less workers or less in terms of resources. What do you do? The easy answer would be, as I've seen in some advice columns, to change your job. Not so easily done in an economy that appears to be shrinking, nor is it always possible to fit in a college degree or time to learn additional skills. To preserve your mental and physical health, you have to be the one in charge of your after-work life. How do you do that?

Begin when you get up. If you are going to have breakfast, do some in-place exercises while preparing whatever you'll have. You can find easy exercises, requiring no equipment, on line. Next, plan something for any free time you might have to break the job-home-job cycle. Give yourself any breaks you can to get out and take a walk, sit in a swing, do some gardening (yes, even on your windowsill). Anything that will break the routine can be helpful.

One local radio station now incorporates a "daily laugh" into their programming where they play jokes from comedy club acts. Put some laughter into your life. I don't care if you like The Three Stooges or Wayne's World or whatever, just laugh whenever you can. See the humor in life and, yes, there is humor.

If you need a silly exercise, here's one I use in my presentations. Wiggle your ears. You can't? Have you tried? Give it a try and see what happens.

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Technorati Tags: stress, job, depression, anxiety, mental health

The Debt Crunch and Stress-induced Illness

2008-06-13T15:05:00.000-04:00

A recent Associated Press-AOL poll, which took another look at the debt-stress crunch now affecting the American consumer, found that 44% of the 1,002 people in the survey indicated migraine headaches, 29% had severe anxiety, 23% suffered from severe depression and half of the study participants had some form of muscle tension or back pain. The results, when compared to a previous study completed in 2004, show significant increases in debt-related stress-induced physical problems. It's no secret that chronic stress brings on physical problems and the emotional toll is hefty, as well.

Americans have piled up $957 billion in consumer debt, according to the Federal Reserve, and much of it is in the form of credit card debt. Twenty percent of after-tax income is now earmarked to pay this debt and that leaves household budgets with increasingly less money to spend on essentials.

What can be done? My first thought is for professional help in credit card counseling from a reputable service and then consider lifestyle changes to help you weather this credit storm. You will survive, but just as anyone who's ever been through a tornado knows, you have to begin to sort things out and reorder your priorities.

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Technorati Tags: economy, recession, stress, debt, credit cards, saving money

Depression for Women, Alcohol for Men

2008-06-12T07:00:00.000-04:00

A study which appear in the July issue of Alcoholism: Clinical & Experimental Research has added some interesting new insights into the ways that women and men handle stress. It seems that men seek the stress-reduction method of alcohol consumption while women become depressed.

Why might this be? The researchers think it's because men, perhaps, have been socialized to use alcohol or that there are, seemingly, gender-specific brain stress pathways that differ in the sexes. One researcher, however, said she thought it was because women tend to think about negative experiences more while men use distraction techniques, such as alcohol, to calm themselves.

So, is it biological or learned? Perhaps, as in most research findings, a little of both and it indicates that we may need to do a better job of helping men and women learn healthier ways to cope.

Is alcoholism or addiction an issue in your family? We've got support for you on our Addiction and Substance Abuse support group.

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Technorati Tags: stress, men, women, gender, alcoholism

Picture of an Anxious Brain

2008-06-11T07:00:00.001-04:00

The brain, to my mind, is the final frontier that is still being explored and with each exploration we learn more of its incredible secrets. The latest finding on social phobia is brought to us through SPECT (single-photon emission computed tomography) scans which have now verified the biological basis of this problem. We know that two specific neurotransmitters (serotonin and dopamine) seem to be related to the disorder and a small study in Europe has now confirmed an imbalance in the functioning of these chemicals in the brain. The study was published in the May issue of the Journal of Nuclear Medicine. Some 15 million adults in the US suffer from social anxiety disorder.

The researchers point out that this is an important first step to making a connection between the disorder and a biological basis for it. They do, however, caution that they can't say whether the people in the sample had the imbalance prior to the appearance of the disorder. So it would seem that this is yet another example supporting a biologic, genetic, environmental basis for some anxiety disorders and to treat them as medical disorders.

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Image Credit: SNM.org

Technorati Tags: SPECT, social phobia, neurotransmitters, anxiety, imaging

Single Session Therapy: One Session and Out?

2008-06-10T07:00:00.000-04:00

The increasing difficulty with obtaining insurance reimbursement for mental healthcare may have sparked new interest in an even briefer form of therapy that was discussed in a 1995 book by Michael Hoyt, Ph.D. (Brief Therapy and Managed Care, 1995). It is Hoyt's belief, after noting that up to 40% of psychotherapy clients stop after the first session, that therapy can be effective in only one 60-minute or less session.

While therapists may view the patient's failure to continue with therapy after one session, Hoyt sees it as an indication that perhaps only one or two sessions were needed after all. Other psychologists working as a team at the VA have indicated that just one, 60-minute session with even the seriously mentally ill can be effective. They call it a "motivational interview" and it helps to refocus on the primary problem(s) so that the client could zero in on the problem and begin to come up with a plan to resolve them.

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Work, Stress and Mental Health

2008-06-09T18:00:00.001-04:00

Work plays a central role in most people's lives and it is for that reason that the workplace must be one of the most carefully monitored keys to maintaining our mental health. Corporations understand the need for good healthcare for their employees and have even brought in workout equipment, trainers, nutritionists and relaxation experts to help stem the rising cost of employee healthcare. It's a win-win situation when both the employer and the employee realize the gains.

Besides all the programs, where can you find solutions to stress in your workplace? How about spending some time with co-workers and each of you offering support and helpful solutions? Anyone who is currently experiencing high levels of stress needs to understand that they're not alone and they have supportive people around them.

Where do supervisors fit in? Employee Assistance counselors offer both individual help as well as providing programs to teach relaxation and stress-reduction techniques. All employees should be encouraged to take advantage of whichever one is most helpful for them.

What about offering, or requesting if you're an employee, a more flexible schedule where you can keep appointments for mental health or outside appointments with trainers or just to be able to come in late one morning a week and work a bit later on the other days to make up for this? I know many companies that have this flextime arrangement and employees not only enjoy this added freedom, but their attitude toward the company changes. It is this change in outlook at help the corporate environment as well as the bottom line.

Rigid gets us nowhere in terms of our mental health. Even redwood knows they have to bend a bit with the wind in order to survive.

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Technorati Tags: health, stress, happiness, work, balance

Kids, PTSD and Loss

2008-06-02T17:43:00.004-04:00

The loss of a parent is a traumatic event, yet the therapeutic interventions for kids have pretty much centered around the traditional belief that grief needs to be the focus of the therapy. Now, researchers at the University of Georgia have looked at how the inclusion of therapy for PTSD might be effective.

They used a therapeutic camp environment to utilize both grief counseling, PTSD treatment and the usual camp activities with 100 children who had lost a parent. The camp environment and group sessions aided in helping the kids view their situation in relation to that of other kids, too.

Comparing results of this camp experience with that of children who didn't attend the camp, the researchers indicate that continuing to experience severe PTSD was up to 4.5 times greater for the kids who hadn't had the opportunities afforded by the camp. Even looking at grief counseling and camp attendance alone, without the PTSD sessions, wasn't as effective as the combination of the two modalities. So, it would seem that the therapeutic focus for kids with this type of loss has to be broadened. The results are in the May issue of Research on Social Work Practice.

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Technorati Tags: PTSD, grief, loss, death in family, children, camp, counseling

Diagnosis, DSM and Physician Affiliations

2008-05-08T21:20:00.002-04:00

When you go to a psychiatrist or psychologist (or even your primary care physician), the first thing they pull out (whether in your sight or not) is a copy of the DSM (Diagnostic & Statistical Manual), the book that describes every mental disorder with all its symptoms and offers a means of making a diagnosis. It is the Bible of the medical profession and of every insurance company in the world, probably.

The question that needs to be asked, by people who'd like to really understand this book: How is this book constructed and who is involved in deciding what goes into it? Good question. It's a committee, the members can be found in the front of the book, that gets together and, based on their clinical experience and judgment, they make additions or deletions and decides what is to go into the book. There is also another medical "coding" book and that's the ICD-9 which is used for procedure codes and billing purposes. If you'd like information on this, go here. For the DSM, go to the publisher's website (American Psychiatric Publishing, Inc.) and also go to the National Institute of Mental Health for more information.

Are the physicians and psychologists who are on the committee to review and revise the book which describes mental disorders taking money from pharmaceutical firms? Perhaps that's not the right way to phrase that question. Do any of the committee members receive any funding from pharmaceutical firms? Probably most, if not all, do because the nature of research and funding is such that schools, hospitals and foundations cannot fund all work in this area. Funds are needed from pharmaceutical firms and the hope is that this does not cause bias in any form.

Might it cause some bias? Perhaps, but it's my opinion that professionals are not going to agree to revise a diagnosis or add a new criteria just because they have some funding from a firm that makes medications.

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Technorati Tags: DSM, psychology, psychiatry, pharmaceutical funding

Anxiety and Medication Compliance

2008-05-01T15:26:00.001-04:00

No one wants to have a medical illness, especially one that requires that you have to either take pills or use an inhaler on a daily basis or inject yourself. For many, it reinforces the fact that you're "sick" or that you are not able to do what others can. For me, that's one side of the coin, but I think it's better for you, in terms of your compliance with treatment and your self-esteem, to look at the other side.

So, what's the other side of the coin? How about thinking that each pill or injection is proof that you have both the determination to maintain your health and that rather than reinforcing the fact that you're "sick," it means you're a winner. You won't let this stop you, or get you down because you're going to go on with your life and do the things you want.

Need examples? How about the actress Halle Berry who is a diabetic, but decided to be a successful actress and now a mother? How about Lance Armstrong who won the Tour de France multiple times while fighting testicular cancer? How about Bill Russell, the former basketball star, Bernie Mac, the comedian and Karen Duffy, the model, who all have sarcoidosis or Michael J. Fox who is fighting Parkinson's Disease and still is involved in entertainment? Gary Hall, Jr., winner of 10 Olympic gold medals has diabetes and so did Jackie Robinson.

Taking medication to help you control the symptoms of anxiety or depression or any other psychological disorder only makes you better for getting yourself into treatment. It may be anxiety provoking at first and even leave you with some concern, but what do you want to do with your life; live it or be controlled by the illness?

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Technorati Tags: anxiety, medication, diabetes, celebrity, wellness, healthy living

The Iraq War and PTSD: Finding Good from Bad

2008-03-31T18:41:00.001-04:00

The number of casualties from this war is staggering. One piece of information that is particularly of concern is the number of both military and civilian personnel returning to the U.S. with symptoms of PTSD. One of the more difficult of the anxiety disorders to treat and one which has an enormous impact on families, PTSD has now become a focus of intensified research. Both therapy and pharmacologic interventions are being sought to more effectively deal with the trauma that gave birth to the disorder. Just as World War II helped psychologists and neurologists better understand physical brain trauma, this war is pushing the resources in research to look at psychological trauma. The initiative will serve all of us.

The National Center for Posttraumatic Stress Disorder, which is in the US Department of Veterans Affairs, now has both videos and FAQs related to this disorder and related issues. These issues concern the expectations of both the family and the PTSD sufferer. Questions center around actually talking about the topic, and the need to work toward establishing trust and closeness. Additionally, there are links to the resources you and your loved ones will need and how to gain access to them.

I've pasted a link to one site on my self-help page (a NAMI center) and the National Center also has a booklet (Returning from the War Zone: A Guide for Families) available only on-line here and a guide for military personnel is available here.

More specific information can be found at Veterans and their Families and addresses additional issues as well. They also have a video on a topic which has previously received less attention: women in the military. Well-known TV personality Jane Pauley narrates the video on military women.

If you have someone now serving in the military in Iraq or Afghanistan or who has come home, I urge you to visit these links. We all need to know what we can do to help with our veterans' return to a full life of physical and mental health.

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Technorati Tags: Iraq, Afghanistan, veterans, PTSD, family, stress, anxiety

School Stress and Tragedies

2008-02-15T11:50:00.006-05:00

School appears to many to be a time when everything is going right for students and all they need to do is study, get good grades and learn how to be good citizens. Unfortunately, the recent events with regard to campus shootings and other tragedies fly in the face of such beliefs.

The pressures of school are felt by all students, but for some the pressures are more than they feel they can handle. It's at these times, and even before, that efforts need to be made to reach out to these students to help them see that there are solutions for problems, pressures can be handled and help is there for the asking. It is, however, it is this "asking" that may prevent some students from getting the help they need.
How can schools, teachers and parents approach this dilemma and attempt to short-circuit tragedy? The first step must be to recognize where the pressure is coming from and then we can look at ways to help.

Stress in school comes from several areas: schoolwork, expectations of parents, the student's expectations of themselves, and personal relationships. There may also be times of the year when this stress is greater than others. For instance, just around mid-terms and finals time, holidays when students are heading home, or at graduation time. These are all prime stress times because of the added pressure to achieve, the loss of person contacts and support and the new challenges graduates face.

The time to help is when students just enter their school activities and I would urge that all students receive on-going workshops, stress refresher training, and that the counseling office make itself known on a daily basis. We can't always expect these students to come to us and we have to begin to go to them. It's really a mission to reach out to students and their parents because the two, working together, can be most effective in helping.

Things to Remember

Keep the following in mind:

There are no "failures" in life or coursework; everything is a learning experience
Being stressed is a part of life and there are things you can do
Give yourself some mental distance from the problem and talk it over with someone
Asking for help, no matter what the problem, is always a good, positive move
Nobody's perfect

Pin this list up on your desk or the refrigerator or paste it on the wall and look at it daily. It's one way to help you keep a healthy focus on things.

Are you feeling stressed in school? Know someone who is? Try a visit to our support group or discuss things with other members on our Health Cafe message board.

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Gunshots on Campus - Advice for Families

2008-02-14T18:02:00.006-05:00

We send our children to school each day and our older children go away to college to begin learning more life skills to prepare them for their careers, their futures and to have an opportunity for independence. We always expect that they will return to us safely, but that doesn't always happen. When it doesn't, our faith in their safety at school is shaken, and now there's been another shooting in a lecture hall on the campus of Northern Illinois University.

This isn't the first time we've seen this and it's not the first time we've seen it at a university. Who can forget last year's shooting at Virginia Tech or the attack at the University of Texas at Austin when Charles Whitman climbed into the bell tower and held the entire campus prisoner?

What is the appropriate action for the school, the parents, the students and our country? No one has the magic formula, but one thing we do know is that going on with life, as before, won't be easy, but it's the only way to defeat the anxiety and stress being experienced. The trauma of the incident will not disappear, but how everyone responds will make all the difference.

Families are the primary support now and families must be included in any actions taken on behalf of the students. The strength they can provide for each other is not something that can be offered by schools alone.

Reassurance, not overreacting and maintaining calm is essential. The students may not experience any symptoms of stress immediately, but that doesn't mean that the storm is over. Counseling and learning how to use this situation in a positive way is also essential. I am a strong proponent of "good from bad" and I believe we will find some good here, too.

The main thing all of us want to know is what happened and what were the factors that set this deadly plan into place. Those answers are yet to come.

Still concerned or anxious? Come join our discussion on the Health Cafe.

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Technorati Tags: campus shooting, Northern Illinois University, stress

Are Internet Confessions Good for the Soul?

2008-02-08T16:31:00.000-05:00

The new internet rage of posting "confessions" onto willing websites would appear, to some, to have merit in that it allows you to give "voice" to all those pent-up confessions that may be at the bottom of your anxiety, depression or guilt. But is that really so? Where's the real upside to this and what about the other side of the coin, the dark side? Isn't this just a perfect example of voyeurism, aka Peeping Tom Syndrome? Sounds like it to me.

Some therapists believe that depression comes from keeping things bottled up inside you and, perhaps, it can even cause things like cancer. We've heard that it's good to let your rage out, too, because if you don't, it may come back to bite you in an uncomfortable place. Are these pundits correct in their assumptions? I don't believe so and I also have an opinion on whether confession is good for the body and soul.

The pundits assume that keeping these secrets hidden can result in an altered immune system that leaves you vulnerable to disorders and a target for diseases. I'm not sure that's exactly the case here. We know that people who have serious illnesses, such as cancer, often feel depressed and that the depression precedes the diagnosis of cancer. But does that mean that cancer is a direct result of something that caused the depression or that cancer causes a biological change which leads to depression? Both would seem likely possibilities, but the depression causing cancer idea really hasn't played out in the research I've seen.

The research isn't as straightforward as we would like and there are plenty of studies that seem to prove some point or another. In the social sciences, we refer to it as cherry-picking, or selecting the studies that seem to prove your point. Every grad student has been called on that one. Once we look at the studies carefully, we find they don't hold up and there were factors which weren't considered. It's the nature of human beings. Some will feel better after confessions and some may just feel better after a brisk walk and no confession.

But what about confessions on the internet? Isn't it just a harmless exercise that will, indeed, lead to relief of symptoms and promote health? I'm definitely not sure here and, in fact, I think it may have more of that underbelly to which I referred earlier. Once you begin to reveal things, there will be people who will be waiting for you like a lamb going to its final reward on the dinner table. The more people out there, the greater the possibility, in fact the probability, that you will have someone stalking you, trying to find you or wanting to play with your head. Where's the benefit in harassment?

The internet already has enough people disguising themselves as someone they're not. The idea of "confessions" will just be too tempting for them. There will also be those who make up confessions just to shock the reader and get their joy that way. Then there will be others who will concoct incredibly horrible stories of life that will make people want to cry, only to be taken in.

Internet confessions good for your health? I think not. Something you'll regret? Possibly.

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Technorati Tags: postsecret, online, confession, depression, anxiety, internet

Britney, Privacy and Dr. Phil

2008-01-10T16:27:00.001-05:00

Photo by Gregg O'Connell

The deed has been done and there's the devil to be paid, if I were to paraphrase one of those old adages. In this case, Britney Spears' privacy and her sense of being able to make decisions on her own, have both been violated by Phil McGraw, Ph.D., an unlicensed psychologist and well-known TV personality. McGraw, from the reports of family representatives, was asked to help in assisting the family in getting help for Britney, then a patient in Cedars-Sinai Medical Center in California.

What are the many problems here? For one thing, according to the law, Britney is in charge of her life, not her parents and they cannot make decisions about who may visit her in any facility she may be at any time. Even teens have this right, so McGraw was clearly in violation of Britney's rights and he further compounded the problem when he made a display of his wish to speak out about the situation. And this would do what, Phil? Make her even more determined to run and suspect just about everyone around her? When did McGraw become such an advocate for Britney or anyone else? He runs a TV show, not a clinic, private practice or rehab facility. While he was licensed in Texas for 20 years, he's no longer licensed in any state in the United States, so calling him 'doctor' is leaving people with the wrong impression.

The spin on this story compounded the problem further. One source said she walked out of her room when he came in because she didn't invite him in the first place. He didn't stay for the hour he contends, but 15 minutes according to some sources . Maybe her Southern sense of etiquette did her in here because she did return after walking out.

Then McGraw said he planned a TV show on her plight. Duh, who couldn't have seen that one coming down the freeway? Now he's all miffed that he was some sort of champion and they're trying to muzzle him and put it in a self-serving light. Phil, wake up and smell the roses, yourself. You did a bad, bad thing and it has earned you no kudos. And you're painting yourself as the victim here? As you'd say on your show, what were you thinking?

Treatment for any psychiatric disorder is a delicate, highly personal matter and it has to remain so. It reminds me of the Frances Farmer case where they found the highly acclaimed actress too much to handle, so they had her committed to a psychiatric hospital where she was sexually abused for years. I'm sure those visions, even though she probably never heard of Farmer, are in Britney's head at this very minute. How is she going to manage to come back from this and take over her own life again?

She's already fled, via private jet, to the East Coast and I suspect she's going to become even more suspicious about everyone around her. Instead of the help she needs, McGraw has pushed her further from it by his antics.

Shame on you, Phil McGraw.

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Technorati Tags: Britney Spears, Dr. Phil, health, wellness, privacy, HIPAA, privacy rights, celebrity, psychiatry

Britney Spears - Toxic Celebrity

2008-01-04T16:28:00.001-05:00

The media is all over Britney Spears and her problems, calling it a "meltdown". It seems that when direct Britney news cools down, there's a rush to see who else can be turned over the coals a bit.

Brit's mom, Lynne Spears, has seen her life change from success story to finger-pointing "whodunnit" melodrama. Her book deal has been put on hold after her younger daughter revealed her pregnancy and now her older daughter has been taken, via ambulance, to a hospital for psychiatric observation.

Mommy Spear-est?

Is Mom to blame for all of this or should Britney be held responsible for her life now that she is an adult and a mom of two young boys? I don't think the finger-pointing is going to help one bit and I do believe in personal responsibility. Lynne Spears can be supportive, but she can't be held responsible for Britney's actions now. Her daughter has to curb her own behavior, admit she has to deal with some very serious personal problems and face the consequences of her actions. It's time for professional intervention of many sorts, it would seem.

This latest news also points out how the Spears household has a lot in common with many other homes in this nation. They have their problems and conflicts, but there's an added burden that most people don't consider and that's celebrity.

Consider how you would function if every action in your life, 24 hours a day, were photographed or videotaped and people said things that were hurtful, disturbing and not totally honest? It's called overload and if it goes on long enough anyone would have a melt-down. You begin to wonder who your friends are, who is selling stories about you, and you might want to just be left alone but they keep pushing and no one seems able to step in and help you get a grip on reality. Reality may often not feel 'real' anymore and you begin to wander around in a daze. Could this have happened to Britney? Really, no one knows what's really inside her personal world.

Lynne Spears has asked for prayers for her daughter and I think that's a good idea. Things as they stand now are too much like one of Tennessee Williams' plays and they were no laughing matter. Leave the girl and her family alone. No one should be dogged this way.

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Update 1/7/2007:

Technorati Tags: Britney Spears, Lynne Spears, mental health, celebrity, crisis, stress, anxiety

Fatal Error: One for the Road

2007-12-31T16:36:00.001-05:00

The New Year begins and all over America people believe that it must be ushered in with a glass or two of some alcoholic beverage. It has become a part of our culture and even recovering alcoholics want to celebrate with a non-alcoholic beverage that has all the appearance of an alcoholic drink. It seems that even here we see the strong influence of alcohol and celebration. Some people believe it's not a celebration if it doesn't include alcohol and others use "celebration" as a means to an even greater intake of anything alcoholic.

Alcohol has been found to have some benefit, according to recent studies, but the researchers also indicated that meant one or two drinks a day, not one or two an hour. So, the research doesn't support excessive drinking and, certainly, not binge drinking as we may find on holidays.

As to traffic accidents, we can only estimate the toll that takes on everyone's life; the driver, the victims, everyone's family, the police, insurance rates and even ER personnel. No one is left unscathed by these accidents. The group with the highest incidence of driving while drunk and in traffic accidents includes those between the ages of 21-25 where over 27% of them drove drunk.

What do we need to do about this excess and the recklessness that comes with alcohol when driving? For one thing, alcohol isn't a means to dampen your social anxiety, although we see many people with anxiety or panic disorders drinking to self-medicate.

Just as it takes a village to raise a child, it takes all of us to help potential alcoholics not become full-blown drunk drivers and we need to learn ways to short-circuit the tantrums that come with it. Take the keys, have a designated driver, or take a taxi.

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Technorati Tags: parties, alcohol, drunk driving, safety, New Years, celebrations

Photo: iStock Photography

The Piggybank Mentality: Money and Sanity

2007-12-26T04:27:00.000-05:00

The season for giving gifts and racking up that $17.3 billion in credit card debt that has Americans swimming in a sea of red ink is over and now the average consumer/gift-giver has to face some very unpleasant music. You can't undo what's been done but you can do something about maintaining your sanity in the year to come. We've heard mixed comments about the economy and I don't have to be a credit analyst to know that times are going to get rougher in terms of mortgages, credit card payments and paying for gas for the family car.

The secret to survival and maintaining your sanity is to begin now to 'look for that silver lining' that old song told us about. What can you do?

Stress, in many families, is increased by financial problems. We know that more family arguments have a basis in family finances. Instead of arguing about everything, come to terms with your situation and begin to work together now to improve your future.

I think that the piggy bank is here to stay and it should be a symbol for us to help us remember that saving rather than spending to the limit is the only way out of this.

I heard an economist talk about how we are not pushing the country's production by what we want and need, the forces of production are pushing us to buy, buy, buy and too many people are responding to this pied piper.

The Road to Sanity

The road to sanity is paved with several things:

Get a grip on your spending and ask yourself one question: Do I really need this?

Take that loose change in your pocket and put it in the piggy bank, then into a savings account

Sit down and make a budget that reflects what you actually have to spend and stick to it

See a financial counselor if your credit cards are going to get you into serious problems

How many credit cards do you really 'need' and how many can be either shredded or renegotiated for a lower rate?

When you take action, no matter how small it seems, it gives you a sense of empowerment. Instead of having a tantrum or growling at your kids or co-workers, be responsible now for past actions. The years of acting like a kid and just scooping up all those glossy, unnecessary goodies are gone. Reality does bite, but you have the remedy and it's not in drugs or alcohol.

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Technorati Tags: holiday, stress, money, credit, money management
Image Credit: iStockPhoto.com